Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD4001 Week 9 > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What is palliative care?

A

Palliative care is an approach that improves the QoL of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is end of life

A

Likely to die in the next 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who are those that are facing imminent death?

A

Advanced, progressive, incurable conditions

General frailty

At risk of dying from sudden crisis of condition

Life threatening conditions caused by sudden catastrophic events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the principles of delivering good end of life care?

A

Open lines of communication

Anticipating care needs and encouraging discussion

Effective MDT input

Symptom control-physical and psycho-spiritual

Preparing for death

Providing support for relatives both before and after death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are physical causes of pain?

A

Cancer related

Treatment related

Associated factors- cancers and debility

Unrelated to cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the different pain syndromes?

A

Bone

Nerve

Liver

Raised intracranial pressure

Colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe bone pain?

A

Worse on pressure or stressing bone/ weight bearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe nerve pain?

A

Burning

Shooting

Tingling

Jagging

Altered sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe liver pain?

A

Hepatomegaly

RUQ tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe RICP?

A

Headache worse with lying down, often present in the morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe colic pain?

A

Intermittent cramping pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different steps in WHO control?

A

Non-opioid- aspirin, paracetamol or NSAID

Weak-opioid- codeine

Strong opioid- morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a alternative to step 2 in the WHO ladder?

A

Dihydrocodeine

Tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is an alternative to step 3 in the WHO ladder?

A

Diamorphine

Fentanyl

Oxycodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the indications of opioids?

A

Moderate to severe pain or dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the actions of opioids?

A

Opioid receptor agonist

Centrally acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the cautions with opioid?

A

Renal impairment

Avoid in acute respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do administer opioids?

A

Enterally- oral and rectal

Parenterally- IM/ SC injections

Delivery via syringe driver over 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the principles of starting strong opioids?

A

Stop and step 2 weak opioids

Titrate immediate release strong opioid

Convert to modified release form

Monitor response and side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is modified morphine release prescription used for?

A

Background pain relief

21
Q

When do you take modified morphine release?

A

Twice daily preparation at 12 hourly intervals

Or once daily at 24 hourly intervals

22
Q

When do you take immediate morphine release?

A

Breakthrough pain

As required

23
Q

Example of immediate release drugs?

A

Oramorph liquid

Sevredol tabs

24
Q

Describe the use of diamorphine?

A

Semi-synthetic morphine derivative

More soluble than morphine so smaller volumes needed

Can be used for parenteral administration

25
Q

What can switching opioids cause?

A

Opioid sensitive pain with intolerable side-effects

26
Q

What is oxycodone?

A

Second line opioid

27
Q

What is the side effects of oxycodone?

A

Less hallucinations

Itch

Drowsiness

Confusion

28
Q

Describe the use of fentanyl patch?

A

Second line opioid

Lasts 72 hours

Only use in stable pain

Useful if oral and subcutaneous routes not available

Useful if persistent side effects with morphine/ diamorphine

29
Q

What are the most common opioid side effects?

A

Nausea and vomiting

Constipation

Dry mouth

Biliary spasm

Watch for signs of opioid toxicity

30
Q

How can you manage constipation?

A

Stimulant and softening laxative

Senna/ Bisacodyl + docusate

Macrogol e,g laxido/ movicol

OR Co-Danthramer alone

31
Q

How can you manage nausea?

A

Antiemetic

Metoclopramide

Haloperidol (consider QT interval)

32
Q

Example of opioid toxicity symptoms?

A

Shadows edge of visual field

Increasing drowsiness

Vivid dreams/ hallucination

Muscle twitching/ myoclonus

Confusion

Pin point pupils

Rarely, respiratory depression

33
Q

What adjunct medication would you use for liver capsule pain/ raised intracranial pressure?

A

Steroids

Remember to consider gastroprotection

34
Q

What adjunct medication would you use for neuropathic pain?

A

Amitriptyline

Gabapentin

Carbamazepine

35
Q

What adjunct medication would you use for bowel/bladder spasm?

A

Buscopan

36
Q

What adjunct medication would you use for bone pain/ soft-tisse infiltration?

A

NSAIDs

Radiotherapy for bony metastases

37
Q

What are syringe drivers?

A

Delivery over 24 hours usually sub-cutaneously

Useful wehn oral route is inappropriate

Often useful for rapid symptoms control

Multiple medications can be added

Stigma of being on a pump

38
Q

What are the four factors of total pain?

A

Physical

Social

Spiritual

Psychological

39
Q

What feeds into physical pain?

A

Side effects

Co-morbid causes

primary disease

Treatment

40
Q

What feeds into social pain?

A

Financial concerns

Worries about family

Loss of role/ status

Dependency

41
Q

What feeds into psychological pain?

A

Depression

Anxiety

Fear of suffering or pain

Experience of past illness

42
Q

What feeds into spiritual pain?

A

Loss of faith

Anger at God

Fear of death and unknown

Existential

43
Q

What is psycho-spiritual distress?

A

Impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, nature or a power greater than oneself

44
Q

When does psycho-spiritual susually occur?

A

At diagnosis

At home after initial treatment

At disease progression or recurrence

At the terminal phase

45
Q

How do you manage psycho-spiritual distress?

A

Encouraging hope, purpose and meaning

Respecting religious/ cultural needs

Affirming the patient’s humanity

Protecting the patient’s dignity, self worth and identity

Encouraging relationships

Encouraging forgiveness

Refer to colleagues in wider MDT/ specialist

46
Q

How has COVID affected grief?

A

Reduced professional support

Risk of reduced quality of care

Strains on informal care networks

Increased loss, grief and bereavement

47
Q

What is the better concept of bereavement and grief?

A

Disease modifying or potentially curative intervention, increasing till death

Supportive and palliative care increasing till death

Treatment decreases over time after death, not immediately

48
Q

What are the different forms of grief?

A

Anticipatory grief

Non-complex grief

Complex/ Unresolved grief

Grief is not a measure of the relationship between the bereaved and the deceased

49
Q

How to treat grief?

A

Listen to their story

Hold their pain

Acknowledge the persons loss

Mirror the words and phrases used by the person

MD4001 Week 9 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions